When and how to report results of surgery on atrial fibrillation.
OBJECTIVE
Several medical, interventional and surgical techniques are used to treat atrial fibrillation, aimed at different goals and having variable success rates. To be able to assess and compare all these techniques a methodology of study and a classification is proposed.


METHODS
We developed a five grade score, named the Santa Crus Score, based upon the post-operative atrial rhythm and the effective atrial contraction. Score 0 corresponds to a persistence of atrial fibrillation, the presence of a regular rhythm is grade 1, 2 or 3 if there is no atrial contraction; right atrial contraction; or bilateral atrial contraction, respectively. Score 4 corresponds to sinus rhythm and bilateral atrial contraction. Surgery for atrial fibrillation was performed on 51 patients since 1992. All patients but two had associated mitrial surgery. Three different maze techniques were performed on 17 patients and the pulmonary veins isolation procedure on 34 patients. Patients were reassessed at 1, 6, 12, 24 and 36 months.


RESULTS
After the maze I procedure atrial fibrillation eradication was achieved in 88% of patients but none scored 4. Three patients changed score during the first year. All maze III patients scored 0 initially and one changed to score 3 in the first year. Sixty percent of the maze IIIA patients scored 4, but one evolved to score 0 at 6 months. The pulmonary veins isolation technique eliminated atrial fibrillation in 71% of the patients initially, and in 60% after 1 year, and achieved a score of 4 in a third of the patients.


CONCLUSIONS
This classification considers the intermediate grades of success that can occur with absence of atrial fibrillation and is applicable to all forms of therapy.
Melo
J Q
JQ
Department of Cardiothoracic Surgery, Hospital de Santa Cruz, Linda-A-Velha, Portugal.
Neves
J
J
Adragão
P
P
Ribeiras
R
R
Ferreira
M M
MM
Bruges
L
L
Canada
M
M
Ramos
T
T
D000293:Adolescent; D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery*; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000503:physiopathology; D006801:Humans; D008297:Male; D008499:Medical Records; D008722:Methods; D008875:Middle Aged; D011667:Pulmonary Veins / Q000601:surgery; D016896:Treatment Outcome